Experience of a single center in the conservative approach of 20 consecutive cases of asymptomatic extracranial carotid artery aneurysms

Eur J Neurol. 2018 Oct;25(10):1285-1289. doi: 10.1111/ene.13720. Epub 2018 Jul 11.


Background and purpose: The clinical course and optimal treatment strategy for asymptomatic extracranial carotid artery aneurysms (ECAAs) are unknown. We report our single-center experience with conservative management of patients with an asymptomatic ECAA.

Methods: A search in our hospital records from 1998 to 2013 revealed 20 patients [mean age 52 (SD 12.5) years] with 23 ECAAs, defined as a 150% or more fusiform dilation or any saccular dilatation compared with the healthy internal carotid artery. None of the aneurysms were treated and we had no pre-defined follow-up schedule for these patients. The primary study end-point was the yearly rate for ipsilateral ischemic stroke. Secondary end-points were ipsilateral transient ischemic attack, any stroke-related death, other symptoms related to the aneurysm or growth defined as any diameter increase.

Results: The ECAA was either fusiform (n = 6; mean diameter 10.2 mm) or saccular (n = 17; mean diameter 10.9 mm). Eleven (55%) patients with 13 ECAAs received antithrombotic medication. During follow-up [median 46.5 (range 1-121) months], one patient died due to ipsilateral stroke and the ipsilateral cerebral stroke rate was 1.1 per 100 patient-years (95% confidence interval, 0.01-6.3). Three patients had ECAA growth, two of whom were asymptomatic and one was the patient who suffered a stroke.

Conclusions: In this retrospective case series of patients with an asymptomatic ECAA, the risk of cerebral infarction is small but not negligible. Conservative management seems justified, in particular in patients without growth. Large prospective registry data are necessary to assess follow-up imaging strategies and the role of antiplatelet therapy.

Keywords: aneurysm; asymptomatic; carotid artery; conservative; extracranial.

MeSH terms

  • Adult
  • Aged
  • Aneurysm / diagnostic imaging
  • Aneurysm / therapy*
  • Carotid Artery Diseases / diagnostic imaging
  • Carotid Artery Diseases / therapy*
  • Carotid Artery, Internal / diagnostic imaging*
  • Computed Tomography Angiography
  • Conservative Treatment*
  • Female
  • Humans
  • Ischemic Attack, Transient / diagnostic imaging
  • Magnetic Resonance Angiography
  • Male
  • Middle Aged
  • Registries
  • Retrospective Studies
  • Stroke / diagnostic imaging